Wednesday, November 28, 2007

1.4 Jumping the gun

Of course there are always innovative doctors, some have tried to medically "cure" myopia or prevent myopia from progressing. Again, this dates back several decades. The rationale was since near work, i.e., reading (this was the pre-CRT ancient period, no computers or TVs, what video games, etc) seems to cause myopia, and since reading requires accommodation, then by paralyzing accommodation, myopization should be preventable.

Accommodation is a process by which the crystalline lens inside the eye increases its thickness and curvatures through the contraction of the ciliary muscle. This way more refractive power is gained for focusing at close range. Incidentally, in people over age 42, the crystalline lens can no longer change shape. Reading glasses are therefore needed to supplement the power. This condition is known as presbyopia. (Note: If you have distance correction as well, then get multifocals; when made correctly, they are wonderful.)

Funny thing is that by using a group of cycleplegic eyedrops which not only dilate your pupils but also shut down accommodation, myopia progression was actually slowed and sometimes reversed in treated school children. Great news, right? Well, not quite.

The problems are (1) pupils remain dilated for long periods of time, meaning sunglasses are needed and (2) no accommodation, no reading. Neither is compatible with the lifestyle of a school child. I would have chosen to wear glasses myself. Plus, no one knows the long-term effect of these cycloplegics.

So the medical treatment has been semi-forgotten for a while until more recently when there has been some change in the dosing regimen. For example, the cycloplegics can be applied to only the more near-sighted eye until the other eye catches up with the refractive error, then treat the other eye next, and so on. This type of monocular mydriasis/cycloplegia is more acceptable and well-tolerated by the children. Ideally, if only accommodation is paralyzed but the pupil dilation is spared, i.e., more specific eyedrops. Then the use of these drops should be promoted, especially for prevention. Let's say, 80% of the school children will eventually develop myopia, then by treating all, we are only over-treating 20%. Not too bad a deal.

Even more recently, there have been trials of accommodation-specific eyedrops. Unfortunately, the results are not that much different from the old cycloplegics.

Now, is the cycoplegic treatment of myopia based on irrefutable scientific evidence? Not really. We just know the eyedrops worked. Obviously more R&D is needed.

Come to think of it, the market size for this type of eyedrops is actually quite mind-boggling; although the optical industry may suffer recession as a result. You win some, lose some.

A word of caution: All cycloplegics for myopia are still in clinical trials done only under doctors' direction and care. It is not a DIY project or you'd be suing yourself for practicing medicine without a license or worse, being sued for child abuse.

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